Key result
SCAI-defined PMI linked to ~310% higher 1-year mortality.
Why the study?
Consensus-based biomarker thresholds proposed by SCAI to define periprocedural myocardial infarction had not been validated in the era of high-sensitivity cardiac troponins.
Does SCAI-defined periprocedural myocardial infarction (hs-cTnT >70× URL) predict 1-year mortality in patients undergoing elective percutaneous coronary interventions?
Does SCAI-defined periprocedural myocardial infarction (hs-cTnT >70× URL) predict 1-year mortality in patients undergoing elective percutaneous coronary interventions?
SCAI-defined periprocedural myocardial infarction using hs-cTnT (>70x URL) is a highly specific but insensitive predictor of 1-year mortality after elective PCI, with a lower threshold (>10x URL) offering a better balance of sensitivity and specificity.
SCAI-defined PMI marks higher 1-year mortality after elective PCI; extends observational support for SCAI criteria but leaves optimal thresholds and interventions open.
Background: The magnitude of prognostically relevant myocardial injury after percutaneous coronary interventions remains poorly defined. The Society for Cardiovascular Angiography and Interventions (SCAI) proposed marked biomarker elevations to define periprocedural myocardial infarction (PMI). These consensus-based thresholds have not been validated in the era of high-sensitivity cardiac troponins. We sought to assess the prognostic impact of SCAI-defined PMI and explore optimal prognostic thresholds of high-sensitivity cardiac troponin T (hs-cTnT) after elective percutaneous coronary interventions. Methods and Results: We evaluated patients who underwent elective percutaneous coronary interventions at 2 tertiary care centers with serial hs-cTnT measurements. PMI was defined as peak postprocedural hs-cTnT >70× upper reference limit (URL) in patients with nonelevated (≤1× URL) baseline levels; or incremental increase >70× URL in patients with elevated baseline levels. The primary outcome was 1-year all-cause mortality. Of 8140 patients, 220 (2.7%) died within 1 year. In multivariable analyses, patients with SCAI-defined PMI (n=140; 1.7%) had a higher risk of 1-year mortality (12.9% versus 2.5%, adjusted hazard ratio 4.10, 95% CI 2.51–6.68; P <0.001) as well as cardiac mortality (11.4% versus 2.1%, adjusted hazard ratio 4.21, 95% CI 2.50–7.11; P <0.001). Based on receiver operating characteristics analysis, the optimal prognostic threshold of hs-cTnT was >10×URL, observed in 14.6% of patients. This threshold showed lower specificity (85.7% versus 98.4%) but higher sensitivity (25.4% versus 8.2%) and better overall performance for prediction of 1-year mortality compared with the SCAI-defined cutoff value of troponin. Conclusions: In patients undergoing elective percutaneous coronary interventions, SCAI-defined PMI emerged as an independent, highly specific, but insensitive predictor of 1-year mortality. Optimal trade-off between sensitivity and specificity was observed at a lower threshold of hs-cTnT (10× URL) in this cohort.
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Koskinas et al. (2018) studied this question. SCAI-defined periprocedural myocardial infarction was associated with a 12.9% 1-year mortality rate compared to 2.5% in those without PMI (HR 4.10, P < 0.001).
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